Uveitis refers to a group of inflammatory conditions
that occur in the eye. Often uveitis reflects diseases that are
developing elsewhere in the body. Sometimes uveitis is the first
evidence of disease in the body. In most cases, the cause of uveitis
Inflammation vs. Infection
The symptoms of inflammation are swelling, redness,
and dilated blood vessels. Infection occurs when a germ is growing
in tissue. Not all inflammation indicates an infection. Inflamed
joints in arthritis are seldom infected. Scraped skin is inflamed
but not infected. Infection (germs-bacteria and viruses) can also
cause inflammation. In uveitis, inflammation can be due to an infection
or due to non-infective causes.
The symptoms of acute uveitis are frequent pain, red eyes, and light
sensitivity (photophobia). In chronic uveitis, patients complain
of dull aches and/or blurring of vision.
Since many kinds of uveitis have no known cause, they are treated
nonspecifically with corticosteroids (cortisone) to suppress inflammation
and to prevent structural damage to the eye. Corticosteroids may
be addressed in the form of eyedrops, ointments, injections next
to the eye, or pills. Corticosteroids in the pill form (prednisone)
can have serious side effects. As a result, Ophthalmologists treat
most cases of uveitis with eyedrops or injections of corticosteroids
next to the eye. Even "local" corticosteroids have side effects,
including cataracts, glaucoma, and the loss of ability to fight
infections around the eye caused by bacteria, fungi, or viruses.
Any patient on corticosteroids must be carefully monitored for side
effects by an Ophthalmologist.
Common types of uveitis
Acute iritis (inflammation of the iris) affects young adults. It
begins abruptly with symptoms of pain, redness, and photophobia
(light sensitivity). Often, patients have a genetic tendency to
acute iritis, and other family members may have had iritis. This
genetic tendency often predisposes patients to other diseases such
as ankylosing spondylitis (arthritis of the lower back), inflammatory
bowel disease (colitis), and psoriasis (scaling skin disease).
By and large, attacks of uveitis last for two to six weeks and usually
occur only in one eye. Some patients have only one or two attacks
in a lifetime, and others have multiple episodes. Acute iritis is
usually treated with eyedrops but occasionally pills or injections
Chronic iridocyclitis affects
the iris and ciliary body (glandlike structure) behind the iris.
Chronic iridocyclitis often displays few symptoms but can severely
damage the eye. This is especially true in children who have juvenile
rheumatoid arthritis. In these children, especially in girls aged
2 to 6 years, this is a potentially blinding condition. Many of
these children do not complain about problems with their sight.
Therefore, it is important for pediatricians to refer all children
with juvenile rheumatoid arthritis to an Ophthalmologist for evaluation.
Since chronic iridocyclitis may start years after the juvenile rheumatoid
arthritis began, children with this form of arthritis should have
periodic checkups into their teenage years.
Pars planitis tends
to occur in teenagers and young adults. The cause is unknown, and
pars planitis is not associated with any systemic disease (disease
of the whole body). The frequent symptoms are those of blurred vision
or floaters (spots before the eyes). Most patients with pars planitis
have a promising outcome after treatment. However, a few patients
have severe visual problems.
Toxoplasmic retinitis is
an infection of the retina caused by a protozoan parasite. Over
30% of the American population is exposed to this parasite. If a
pregnant woman is infected, her infant is at risk of eye disease
and even mental retardation. Besides acquiring this parasite at
birth, people can also be infected by eating raw or undercooked
meat or by handling cat feces.
Infection of the retina by toxoplasmosis can
be blinding. In most cases, antibiotics can control the infection
and suppress the inflammation. However, the infection is rarely
cured and can be reactivated. The Uveitis Clinic at the University
of Illinois was the first to use "quadruple antibiotic therapy"
to treat toxoplasmosis. Due to the success of this therapy, many
other centers now use it to treat this difficult infection.
an inflammation of unknown cause. It can affect any part of the
body but is most commonly found in the lungs, skin, and eyes. In
the eyes, it can cause iritis or chorioretinitis (disease of the
retina and choroid). Usually the symptoms are decreased vision and
mild discomfort around the eyes. Most cases of sarcoidosis of the
eye are treated with corticosteroids.
A final type of uveitis is viral
retinitis. Herpes viruses,
(including CMV, cytomegalovirus),
which are normally kept at bay by the patient’s immune defenses,
can, at times, destroy the retina. People whose immunity has been
weakened due to diseases such as cancer or AIDS (acquired immunodeficiency
syndrome) or from chemotherapy are at greater risk than others for
this type of infection. Until recently if the immunity of these
patients could not be restored, there was little that could be done
to prevent damage to their eyes. Fortunately, new antibiotics have
been developed that seem to work well against these viruses.